Abstract

Background

The follow-up of HIV-exposed infants remains a public health challenge in many Sub-Saharan
countries. Just as integrated antenatal and maternity services have contributed to
improved care for HIV-positive pregnant women, so too could integrated care for mother
and infant after birth improve follow-up of HIV-exposed infants. We present results
of a study testing the viability of such integrated care, and its effects on follow-up
of HIV-exposed infants, in Tete Province, Mozambique.

Methods

Between April 2009 and September 2010, we conducted a mixed-method, intervention-control
study in six rural public primary healthcare facilities, selected purposively for
size and accessibility, with random allocation of three facilities each for intervention
and control groups. The intervention consisted of a reorganization of services to
provide one-stop, integrated care for mothers and their children under five years
of age. We collected monthly routine facility statistics on prevention of mother-to-child
HIV transmission (PMTCT), follow-up of HIV-exposed infants, and other mother and child
health (MCH) activities for the six months before (January-June 2009) and 13 months
after starting the intervention (July 2009-July 2010). Staff were interviewed at the
start, after six months, and at the end of the study. Quantitative data were analysed
using quasi-Poisson models for significant differences between the periods before
and after intervention, between healthcare facilities in intervention and control
groups, and for time trends. The coefficients for the effect of the period and the
interaction effect of the intervention were calculated with their p-values. Thematic
analysis of qualitative data was done manually.

Results

One-stop, integrated care for mother and child was feasible in all participating healthcare
facilities, and staff evaluated this service organisation positively. We observed
in both study groups an improvement in follow-up of HIV-exposed infants (registration,
follow-up visits, serological testing), but frequent absenteeism of staff and irregular
supply of consumables interfered with healthcare facility performance for both intervention
and control groups.

Conclusions

Despite improvement in various aspects of the follow-up of HIV-exposed infants, we
observed no improvement attributable to one-stop, integrated MCH care. Structural
healthcare system limitations, such as staff absences and irregular supply of essential
commodities, appear to overshadow its potential effects. Regular technical support
and adequate basic working conditions are essential for improved performance in the
follow-up of HIV-exposed infants in peripheral public healthcare facilities in Mozambique.